Medicare is a federal health coverage program paid for through employment taxes and premiums. There are several parts to Medicare. You will be most familiar with the following:
Medicare Part A is hospital insurance for the aged, disabled and individuals who have ESRD. Part A helps pay for care in a hospital and skilled nursing facility and for home health and hospice care. There is no cost for Part A for individuals who meet the work requirement or who are the dependent(s) of an individual who meets the work requirement. Individuals age 65 or older who do not meet the work requirement may purchase Part A by paying monthly premiums.
Medicare Part B is medical insurance which helps pay for doctor bills, outpatient hospital care (including dialysis), and various other services not covered by Part A. To qualify for Part B, a person must be entitled to Part A. Part B is optional and requires the payment of monthly premiums.
Medicare Part D is a prescription drug plan for people with Medicare. Part D is optional. It requires selection of a plan. Depending on the plan, there may be a monthly premium, co-payments, or deductables.
Here are some resources that can help providers and patients better understand the prescription drug plans:
Medigap Plans (Medicare Supplemental Plans)
By a different federal law, those who are 65 can purchase a Medigap plan during the first 6 months they have Medicare. A number of states have regulations that allow those younger than 65 to purchase at least one Medigap plan during the first 6 months they have Medicare. You can see which ones at http://www.medicare.gov/find-a-plan/questions/medigap-home.aspx .
More information about Medigap coverage can be found at http://www.cms.gov/Medigap/.
Medicare has changed the way it reimburses for dialysis services. Several of the common services provided to dialysis patients will be “bundled” together into one payment. This will likely include the dialysis treatment, regular lab work, and some medications. There is concern that this will push cost off onto the patient. The organization Dialysis Patient Citizens has developed an informational brochure on this bundling, which is available for download.
Page last updated: 9/9/2014